Discharge rates for nontraumatic lower extremity amputation among diabetic individuals aged 40 years and older declined 65% from 1996 to 2008, according to a study by the Centers for Disease and Prevention, announced by the agency on Jan. 24 and also published in the February issue of Diabetes Care.
The CDC’s study is the first comprehensive study to examine trends in nontraumatic lower extremity amputation (NLEA) rates and characteristics associated with diabetes-related NLEAs in the U.S. population, Yanfeng Li, MPH, and colleagues at the CDC in Atlanta analyzed data from two nationally representative surveys – the National Hospital Discharge Survey (NHDS) and the National Health Interview Survey (NHIS) – and determined that the age-adjusted NLEA discharge rate per 1,000 persons among diabetic individuals aged 40 years or older decreased from 11.2 in 1996 to 3.9 in 2008, while rates among nondiabetic individuals remained similar. However, even with the dramatic decline, the age-adjusted NLEA rate in the diabetic population remained approximately eight times higher than the rate observed in the nondiabetic population, at 3.9 vs. 0.5 per 1,000 persons, respectively, the authors wrote (Diabetes Care Feb. 2012;35:273-7).
When analyzed by demographic characteristics within the diabetic population, the NLEA rates decreased significantly in all of the demographic groups considered. Throughout the 12-year study period, however, the rates were significantly higher among diabetic patients 75 years or older, compared with those aged 40-64 years and those aged 65-74 years, the authors reported. They were also significantly higher among men than women and among blacks than whites, they stated.
Although the findings are limited by several factors, including the underestimation of the size of the total diabetic population (estimates did not include individuals with undiagnosed disease or those in nursing homes); the lack of inclusion of data on NLEAs performed in long-term hospitals, Veterans Affairs hospitals, or outpatient settings; possible duplicity of patients hospitalized more than once in a given year; and the absence of a racial designation for a large proportion of patients, they nevertheless indicate that increased attention to risk-factor management, patient education, and appropriate foot care in recent years have led to a reduction in NLEA hospitalizations, the authors wrote. The persistent racial disparities and continued increased risk for NLEA among diabetic patients suggest more can be done. "Further decreases in rates of NLEA will require continued awareness of diabetes and its complications among patients and providers as well as comprehensive interventions to reduce the prevalence of risk factors for NLEA and to improve foot care and overall care for people with diabetes, particularly for those in subpopulations at higher risk for NLEA," they concluded.
The authors reported having no relevant conflicts of interest.
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